A Case of Primary Adenocarcinoma of the Fourth Portion of the Duodenum Curatively Resected by Pylorus-Preserving Pancreatoduodenectomy

Ryo Suzuki, Norichika Matsui, Kentaroh Nishi, Akimasa Yamashita, Takahisa Matsuoka and Tomoaki Morita

Department of Surgery, Syutoh General Hospital

A 66-year-old man admitted for nausea, appetite loss, and general fatigue was found in an upper gastrointestinal series to have obstruction of the fourth portion of the duodenum. Endoscopy could not reach the lesion. Abdominal computed tomography (CT) showed an enhanced mass 3.8 cm in diameter in the fourth and third portions of the duodenum. Microscopic examination of the resected specimen showed type 3 cancer in the fourth and third portion of the duodenum 30 mm from the anal side of the papilla of Vater. The tumor had penetrated the serous membrane and involved the lymph nodes around the head of the pancreas. In our opinion, pylorus-preserving pancreatoduodenectomy accompanied by lymph node dissection should be considered standard surgery for primary adenocarcinoma of the fourth portion of the duodenum.

Key words
primary adenocarcinoma of the third portion of duodenum, pylorus preserving pancreaticoduodenectomy, node-positive duodenal carcinoma

Reprint requests
Ryo Suzuki Department of Cardiac Surgery, Yamaguchi Prefectural Central Hospital
77 Osaki, Houfu, 747-8511 JAPAN

Accepted
November 30, 2004

To read the PDF file you will need Abobe Reader installed on your computer.